| NPI | 1700920832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: KS 0436606) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KS 0436606) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2023-12-29 |