| NPI | 1003436296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: WI 83825) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 83825) |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2026-05-18 |