| NPI | 1508822461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0058824) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: PA md418282) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2025-02-27 |