| NPI | 1972626059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5101015517) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101015517) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MI 5101015517) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2011-08-26 |