| NPI | 1194254441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS22863) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WV 3601) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2026-02-19 |