| NPI | 1447561964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL OS-11503) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: NY 263425-2) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2019-02-12 |