| NPI | 1891085098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 71743) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MA 1015363) |
| Enumeration Date | 2011-04-09 |
| Last Update Date | 2025-06-24 |