| NPI | 1336167600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T3902) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: GA 066841) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2022-12-16 |