| NPI | 1043239783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: CT 049233) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: ME 011764) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2014-04-30 |