| NPI | 1558595066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 036409) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 036409) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: GA XL1389370) | |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2022-08-25 |