| NPI | 1043401672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 2105) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: ME 2105) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2022-07-25 |