| NPI | 1174553200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 41155) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: TN 41155) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2025-05-19 |