NPI | 1629064423 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD423667) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD423667) |
Enumeration Date | 2005-09-27 |
Last Update Date | 2024-09-05 |