| NPI | 1063979060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine (Licence: AL 35882) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: AL 35882) |
| 2083B0002X Preventive Medicine Obesity Medicine (Licence: AL 35882) | |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2023-05-11 |