| NPI | 1962426890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: TN MD21339) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: LA MD.018736) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MO R6G18) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2016-03-14 |