| NPI | 1124482583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: VA 0101276956) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NC 2021-02593) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: GA 84126) | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2023-08-04 |