| NPI | 1316991870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 89940) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-005148) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: GA 89940) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2022-05-10 |