| NPI | 1669665154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 4301062570) |
| Additional Taxonomies | 208VP0000X (Licence: MI 4301062570) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MI 4301062570) | |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2016-03-11 |