| NPI | 1699854562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL OS9035) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS9035) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2016-06-01 |