| NPI | 1821090663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 229671) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NJ 25MA05668900) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2011-06-06 |