| NPI | 1174577712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: PA MD421377) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD421377) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2024-01-29 |