| NPI | 1376566455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY 53598) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA G86632) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: WA 60784353) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2025-12-03 |