| NPI | 1861423550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: FL ME129389) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 31850) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2017-03-13 |