| NPI | 1952365587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: AL 7014) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 7014) |
| 208D00000X General Practice (Licence: AL 7014) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2020-02-03 |