| NPI | 1699351486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 337237) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 337237) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CT 82329) | |
| 207Q00000X Family Medicine (Licence: CT 82329) | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-11-10 |