| NPI | 1629303870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA PSY003572) |
| Additional Taxonomies | 207LA0401X Anesthesiology Addiction Medicine (Licence: GA PSY003572) |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2023-04-12 |