| NPI | 1922051705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD31236) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101058365) |
| 2083A0300X Preventive Medicine Addiction Medicine (Licence: TN 31236) | |
| 2083A0300X Preventive Medicine Addiction Medicine (Licence: VA 0101058365) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2023-08-14 |