| NPI | 1912062142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: SC 91744) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0101039372) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2024-09-11 |