| NPI | 1164698213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201920) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 02323) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: AL DO 458) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0102201920) | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2013-02-08 |