| NPI | 1104975002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 052971) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: GA 052971) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2023-08-16 |