NPI | 1508850975 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: MA 59874) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 59874) |
208600000X Surgery (Licence: MA 59874) | |
Enumeration Date | 2005-08-31 |
Last Update Date | 2020-05-26 |