| NPI | 1568531424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL ME84820) |
| Additional Taxonomies | 208VP0000X (Licence: FL ME 84820) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2024-01-29 |