| NPI | 1871028894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A157693) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 322809) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2023-07-18 |