| NPI | 1295056281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: TN 4609) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS015816) |
| 207Q00000X Family Medicine (Licence: NY 301496) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 301496) | |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2022-06-06 |