| NPI | 1629207576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2010-01618) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: TX P3697) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NC NC-2010-01618) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2020-10-28 |