| NPI | 1104047695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: FL me0024931) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: FL ME0024931) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2024-11-14 |