| NPI | 1053644344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MT 10150) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MT 10150) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2015-03-23 |