| NPI | 1689661829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: KS 04-31941) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MO 2003010751) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2021-10-19 |