| NPI | 1215550512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: VA 0101283178) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: VA 0101283178) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2025-12-17 |