| NPI | 1871717884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: CA C40058) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX E2292) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ 8675) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-07-08 |