| NPI | 1215550512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: VA 0101283178) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: VA 0101283178) |
| 208D00000X General Practice (Licence: VA 0101283178) | |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2025-03-24 |