| NPI | 1063642361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: TX 48100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 48100) |
| 207Q00000X Family Medicine (Licence: PA MD465443) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD465443) | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2023-10-06 |