| NPI | 1851313399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 108125) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: MO 108125) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2025-04-14 |