| NPI | 1568807592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 26936) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WV 26936) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2025-02-05 |