| NPI | 1043335136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL DO.1371) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: AL DO.1371) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: AZ 3935) | |
| 208D00000X General Practice (Licence: AZ 3935) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: AL DO.1371) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2021-04-29 |