| NPI | 1609849868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 4301098753) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 180754) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2023-05-03 |