| NPI | 1891816427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: MI 4301042187) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MI 4301042187) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2015-10-14 |