| NPI | 1336345735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine (Licence: FL ME68820) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME68820) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2007-07-09 |