| NPI | 1184674848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL ME119623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME119623) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME119623) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME119623) | |
| 207V00000X Obstetrics & Gynecology (Licence: OH 35040988) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL TRN18077) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-06-11 |