| NPI | 1629050794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: SC 0334) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: SC 0334) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2021-12-23 |