| NPI | 1487602082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME77462) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: FL MEM77462) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2020-06-08 |