| NPI | 1144214958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101229792) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MO 2023001690) |
| 207Q00000X Family Medicine (Licence: KS 0429558) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2024-11-05 |