| NPI | 1629174404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 18045) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: WV 18045) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: PA MD042741L) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD042741L) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: WV 18045) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: PA MD042741L) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-19 |