| NPI | 1841285467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: MI 5101012057) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 5101012057) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: MI 5101012057) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2007-07-09 |