| NPI | 1457377657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 33505) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: MN 33505) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2021-04-15 |