| NPI | 1649397647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TX J5583) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX J5583) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2026-01-26 |