| NPI | 1174690606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: AZ 13504) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: AZ 13504) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 13504) | |
| 208D00000X General Practice (Licence: AZ 13504) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2025-05-16 |