| NPI | 1215925185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: TX J6679) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX J6679) |
| 207Q00000X Family Medicine (Licence: TX J6679) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2024-03-26 |