| NPI | 1023002086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: TN MD0000047396) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: AL 00021383) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: TX H1731) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: IN 01025784A) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2015-11-20 |