| NPI | 1003091372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME44750) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME 0044750) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2012-10-24 |