| NPI | 1366731150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MA 277524) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042-0012873) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2019-01-04 |