| NPI | 1376527580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME98798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 42966) |
| 207Q00000X Family Medicine (Licence: FL ME98798) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2023-10-11 |