| NPI | 1710041025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301036405) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MI 4301036405) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MI 4301036405) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: MI 4301036405) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2007-07-08 |