| NPI | 1356363428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: LA 13353) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: LA MD.013353) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2019-05-23 |