| NPI | 1013987916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: DE C1-0004111) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C10004111) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2023-08-18 |