| NPI | 1326740077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 012351) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: AZ 012351) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-06-28 |