| NPI | 1861604761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: TX J5671) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX J5671) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2025-01-28 |