| NPI | 1497781611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: LA 13714R) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 13714R) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2025-04-24 |