| NPI | 1013983063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME0026102) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME0026102) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2021-05-13 |