| NPI | 1548204597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: LA 12771R) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 12771R) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2019-08-21 |