| NPI | 1255368130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H89171) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS010455L) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: PA OS10455L) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-06-26 |