| NPI | 1780610394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 98-00233) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NC 98-00233) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2020-04-08 |