| NPI | 1093758187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: TN 39013) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: MI 4301109047) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2020-08-07 |