| NPI | 1548564545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine (Licence: AL 61-17984) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: OR MD156791) |
| 2083A0300X Preventive Medicine Addiction Medicine (Licence: CO 61-17984) | |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2020-10-26 |