NPI | 1376508481 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 43656) |
Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: WI 43656) |
Enumeration Date | 2006-04-20 |
Last Update Date | 2019-03-25 |