| NPI | 1285676122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME65809) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME65809) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME65809) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-06-11 |