| NPI | 1861423360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: GA 36396) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: GA 36396) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2010-08-19 |