| NPI | 1265926661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022007809) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT216745) |
| 207Q00000X Family Medicine (Licence: PA MD475598) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MO 2022007809) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2025-01-27 |