| NPI | 1851571079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0068666) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101243968) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MD D0068666) | |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2024-07-19 |