| NPI | 1205114816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine Occupational Medicine (Licence: AZ 49232) |
| Additional Taxonomies | 2083A0300X Preventive Medicine Addiction Medicine (Licence: NM MD20130858) |
| Enumeration Date | 2011-07-31 |
| Last Update Date | 2023-06-12 |