| NPI | 1457520090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0101252195) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.054202) |
| 207Q00000X Family Medicine (Licence: PA md443593) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2020-02-07 |