| NPI | 1699769224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 30744) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 30744) |
| 208D00000X General Practice (Licence: NC 30744) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2022-09-09 |