| NPI | 1831314905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: LA MD.022226) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA LA022226) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2022-07-21 |