| NPI | 1609950468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: FL ME97864) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MN 40860) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME97864) | |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: MN 40860) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2019-09-25 |