| NPI | 1538137070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD420382) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD420382) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: VA 0101267603) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2023-03-29 |