| NPI | 1801027602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 55120) |
| Additional Taxonomies | 2083A0300X Preventive Medicine Addiction Medicine (Licence: WI 55120) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2022-11-18 |