| NPI | 1356362263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0057574) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MD D0057574) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2020-03-20 |