| 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 |