NPI | 1659506624 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MN 76576) |
Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: VA 0101274943) |
208D00000X General Practice (Licence: AL 34453) | |
208D00000X General Practice (Licence: CA A148818) | |
208D00000X General Practice (Licence: MS T-3860) | |
Enumeration Date | 2009-05-20 |
Last Update Date | 2024-06-21 |