| NPI | 1790096600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS11485) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL OS11485) |
| 208D00000X General Practice (Licence: FL OS11485) | |
| 208VP0000X (Licence: FL OS11485) | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2025-08-18 |