| NPI | 1205850989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: RI MD06091) |
| Additional Taxonomies | 174400000X Specialist (Licence: RI MD06091) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2025-12-18 |