| NPI | 1184913659 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: AZ 50946) | 
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: AZ 50946) | 
| Enumeration Date | 2011-04-05 | 
| Last Update Date | 2025-06-15 |