| NPI | 1831131499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: LA 08484R) |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2016-09-15 |