| NPI | 1427034529 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME139673) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 14752) | 
| 207QA0401X Family Medicine, Addiction Medicine (Licence: WV 14752) | |
| Enumeration Date | 2005-12-20 | 
| Last Update Date | 2025-08-18 |