| NPI | 1790870558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 47171) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WI 47171) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: WI 47171) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2019-03-07 |