| NPI | 1053810275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MD D0097959) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: MD D0097959) |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2024-07-09 |