| NPI | 1215975180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: TN 0000062117) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0065771) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2025-07-16 |