| NPI | 1487956926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME108353) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME108353) |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2023-06-15 |