| NPI | 1558321976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA VA0102201863) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0102201863) |
| 207Q00000X Family Medicine (Licence: VA 0102201863) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2022-06-09 |