| NPI | 1568755130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 49455) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: AZ 61-19507) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2024-04-21 |