| NPI | 1609920776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MA 46320) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: MA 46320) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2023-03-20 |