| NPI | 1063488831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: TN MD30708) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0101276467) |
| 207Q00000X Family Medicine (Licence: TX T8718) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2025-01-15 |