| NPI | 1952337990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL OS4709) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS0004709) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: FL OS0004709) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2019-09-21 |