| NPI | 1467469320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: NC 2009-00067) |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine (Licence: FL ME0051124) |
| 208D00000X General Practice (Licence: NC 2009-00067) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2016-02-24 |