NPI | 1134304058 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: TX 2014402) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX D6502) |
208D00000X General Practice (Licence: TX D6502) | |
Enumeration Date | 2008-01-09 |
Last Update Date | 2021-02-17 |