| NPI | 1669603957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 261950) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 051858) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CT 051858) | |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2020-11-29 |