| NPI | 1053347591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OR MD24383) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD24383) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2018-01-31 |