| NPI | 1912991522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine (Licence: MA 72453) |
| Additional Taxonomies | 2083A0300X Preventive Medicine Addiction Medicine (Licence: NH 20743) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2025-07-29 |