| NPI | 1053358887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD020500E) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA md020500e) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD020500E) | |
| 207Y00000X Otolaryngology (Licence: PA MD020500E) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: PA MD020500E) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2024-04-24 |