| NPI | 1780678409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 197132-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 1971321) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 197132-1) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2022-07-06 |