| NPI | 1134128341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15523) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: PA OS007632L) |
| 207Q00000X Family Medicine (Licence: PA OS007632L) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2022-07-21 |