| NPI | 1679542294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: AL 16912) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AL 16912) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2023-02-20 |