| NPI | 1134211568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: ND 7777) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND 7777) |
| 207Q00000X Family Medicine (Licence: ND 7777) | |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2026-01-21 |