| NPI | 1891878427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 320747) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: LA 320747) |
| 2083B0002X Preventive Medicine, Obesity Medicine (Licence: LA 320747) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2025-12-18 |