| NPI | 1548452915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NM MD2016-0080) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NM MD2016-0080) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2024-11-07 |