| NPI | 1861458366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: AL 8827) |
| Additional Taxonomies | 208800000X Urology (Licence: AL 8827) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2020-01-24 |