| NPI | 1982872701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: UT 169515-1205) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: UT 169515-1205) |
| 207V00000X Obstetrics & Gynecology (Licence: UT 169515-1205) | |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2020-03-05 |