| NPI | 1760424154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: NM MD2002-0145) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NM 2002-0145) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2010-01-27 |