NPI | 1295716298 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: PA MD425417) |
Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD425417) |
Enumeration Date | 2005-11-08 |
Last Update Date | 2022-06-02 |