| NPI | 1891135430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MO 2014022160) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2014022160) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2023-04-13 |