| NPI | 1982794533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: TX 44530) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101051584) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2014-03-26 |