| NPI | 1982695284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: MA 216680) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 216680) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MA 216680) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2011-03-29 |