| NPI | 1891082699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: AK MEDS8109) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK MEDS8109) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2026-09-09 |