| NPI | 1306065636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 6942268-1205) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: UT 6942268-1205) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2012-08-13 |