| NPI | 1609841006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK MEDO5553) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AK MEDO5553) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: AK MEDO5553) | |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2026-08-17 |