| NPI | 1659506624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: VA 0101274943) |
| Additional Taxonomies | 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 | 2023-08-21 |