| NPI | 1396731857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME70754) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME70754) |
| 207V00000X Obstetrics & Gynecology (Licence: FL ME0070754) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME70754) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2022-07-21 |