| NPI | 1962676049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CT 045237) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: CT 045237) |
| 208D00000X General Practice (Licence: CT 045237) | |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2012-10-10 |