| NPI | 1598757114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: AZ 2226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 2226) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2020-03-06 |