| NPI | 1174513766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 5101014760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5301014760) |
| 208VP0000X (Licence: MI 5101014760) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2022-09-16 |