| NPI | 1639239254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 200200353) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 200200353) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NC 200200353) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2019-10-21 |