| NPI | 1447657911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D39934) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MD D39934) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MD D39934) | |
| Enumeration Date | 2014-11-29 |
| Last Update Date | 2014-11-29 |