| NPI | 1811926819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WI 28714-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 28714-020) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WI 28714-020) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2017-04-27 |