| NPI | 1275684771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MD D0065625) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD036365) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2024-09-20 |