| NPI | 1336433085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: ME MD20886) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 052724) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CT 052724) | |
| Enumeration Date | 2011-05-30 |
| Last Update Date | 2022-01-26 |