| NPI | 1083612485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS003262L) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: PA OS003262L) |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2011-09-14 |