| NPI | 1801946066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 1761) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AK 1761) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: AK MEDS1761) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2021-03-30 |