| NPI | 1992207831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine (Licence: PA MD482489) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: GA 83915) |
| 208D00000X General Practice (Licence: GA 83915) | |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2023-10-25 |