| NPI | 1679536015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: IA 26911) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 1695) |
| 207Q00000X Family Medicine (Licence: IA 26911) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: IA 26911) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2024-03-06 |