| NPI | 1730470113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NM MD2013-0772) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM MD2013-0772) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2015-10-19 |