| NPI | 1952425092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MA 57048) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: VT 042-0007964) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2007-07-27 |