| NPI | 1568630291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: FL OS10159) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS 10159) |
| 207KA0200X Allergy & Immunology Allergy (Licence: FL OS10159) | |
| 208D00000X General Practice (Licence: FL OS 10159) | |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2025-06-16 |