| NPI | 1932100492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME87591) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 63739) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: GA 63739) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2019-05-09 |