| NPI | 1760670178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: DC MD045621) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CT 021810) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2019-12-06 |