| NPI | 1427022524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 44305) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 49356) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TN 44305) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2021-05-17 |