| NPI | 1720490683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0101259297) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101259297) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2022-01-31 |