| NPI | 1295251148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: PR 22355) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: PR 22355) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2023-10-31 |