| NPI | 1154356160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: HI MD4036) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI MD-4036) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-02-25 |