| NPI | 1447332895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MN 65022) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD-427277) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: FL 122450) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: SD 7910) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2022-02-02 |