| NPI | 1225484561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: AL DO.2625) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: TN 3905) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2026-06-16 |