| NPI | 1871723171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: NY 277945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2011-0735) |
| 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: NM MD2011-0735) | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2023-06-03 |