| NPI | 1457930596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NM MD2024-0780) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2024-0780) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2025-11-06 |