| 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 |