| NPI | 1407883820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: LA 016313) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: LA 016313) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2021-10-14 |