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 |