| NPI | 1174572523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0101279714) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: AZ 15609) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2024-09-17 |