| NPI | 1164495057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME0023253) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME0023253) |
| 207Q00000X Family Medicine (Licence: FL me 0023253) | |
| 207P00000X Emergency Medicine (Licence: FL me 0023253) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2018-07-25 |