| NPI | 1316126626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: DC 5270) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: DC 5270) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2010-03-18 |