| NPI | 1871678946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS5496) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL OS0005496) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2013-11-04 |