| NPI | 1023199825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: UT 182809-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 182809-1205) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2021-01-04 |