| NPI | 1184001125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 201800347) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NC 201800347) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2021-03-31 |