| NPI | 1689841488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 258521) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT190346) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2023-06-29 |