| NPI | 1730163023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 5101013821) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101013821) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2018-02-26 |