| NPI | 1477580876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: FL OS9102) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS-002947L) |
| 207Q00000X Family Medicine (Licence: NJ 27575) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2016-09-08 |