| NPI | 1730176900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WV 17401) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 17401) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2024-10-17 |