| NPI | 1871560953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MN 23578) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 23578) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2020-10-16 |