| NPI | 1639270853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 036345) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: SC 150598) |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: GA 036345) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2019-12-23 |