| NPI | 1710967922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02002571A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A15980) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A15980) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2026-08-11 |