| NPI | 1740300094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-33297) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KS 04-33297) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MO 2014012167) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2016-03-04 |