| NPI | 1568564003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MD D52866) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D52866) |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2012-03-19 |