| NPI | 1902899859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CT 034327) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 34327) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2020-01-22 |