| NPI | 1730208166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301088594) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MI 4301088594) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2025-05-27 |