| NPI | 1679156384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CT 081411) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MA 1019289) |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2025-11-17 |