| NPI | 1245204627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: MN 44312) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 44312) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2021-03-04 |