| NPI | 1053366286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 048758) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA E3239Z) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: GA 048758) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2024-08-19 |