| NPI | 1720007271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 45304-020) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WI 45304-020) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-03-21 |