| NPI | 1821167149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: GA 26699) |
| Additional Taxonomies | 173000000X Legal Medicine |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2022-07-25 |