| NPI | 1891714929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: TX K7488) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K7488) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2012-02-29 |