| NPI | 1528030004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MD D39763) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MD D39763) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2008-05-22 |