| NPI | 1821330895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: TN 53238) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 53238) |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2019-10-17 |