| NPI | 1134208994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 20612) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NC 20612) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 20612) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2026-06-09 |