| NPI | 1659378511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD043300L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD043300L) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: PA MD043300L) | |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2020-09-30 |