| NPI | 1770508327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MO R6429) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO R6429) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-01-26 |