| NPI | 1801998810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD41263) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: TN 41263) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2020-02-12 |