| NPI | 1851556369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA MD.205358) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: LA MD.205358) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC LL31155) | |
| 103T00000X Psychologist | |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2012-10-12 |