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 |