| NPI | 1144648312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD193217) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: OR MD193217) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2025-09-23 |