| NPI | 1891884029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-03820) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R7929) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: IA DO-03820) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-05-06 |