| NPI | 1386646610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: FL ME152384) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 39950) |
| 207Q00000X Family Medicine (Licence: ID M-12662) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2022-04-04 |