| NPI | 1376768440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL ME117810) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 69866) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2024-01-22 |