| NPI | 1821152182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1665) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WV 1665) |
| 207R00000X Internal Medicine (Licence: WV 1665) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2021-02-09 |