| NPI | 1063457554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: LA MD.07154R) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: LA MD.07154R) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2021-12-21 |