| NPI | 1134139991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: ID M7882) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M7882) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2018-05-22 |