| NPI | 1720617772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 332736) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 332736) |
| 207Q00000X Family Medicine (Licence: MN 74609) | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-09-26 |