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 |