| NPI | 1679682785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: AZ 33035) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 33035) |
| 207P00000X Emergency Medicine (Licence: AZ 33035) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2025-11-04 |