| NPI | 1942593603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101249165) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0101249165) |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2020-01-30 |