| NPI | 1558335729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 36713) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: NC 36713) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2019-09-04 |