| NPI | 1437214202 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: ID M-3004) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M3004) | 
| Enumeration Date | 2006-12-22 | 
| Last Update Date | 2013-10-17 |