| NPI | 1295716298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: PA MD425417) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD425417) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2022-06-02 |