| NPI | 1376504753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 218319) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 218319) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2019-09-13 |