| NPI | 1730166901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WI 25286) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 25286) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2020-06-30 |