| NPI | 1902868854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 41446) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: VA 41446) |
| 2084P0805X (Licence: VA 41446) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2011-06-22 |