| NPI | 1841239654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO-556) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 1742) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: AL DO-556) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2012-11-26 |