| NPI | 1184823270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: LA MD.204342) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA md204342) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2020-04-06 |