| NPI | 1326787755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 85401) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: WI 85401-20) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2026-08-07 |