| NPI | 1639103567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: LA 8978) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: LA AR3394931) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: LA 19599) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-07-08 |