| NPI | 1942452552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 4301093157) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301093157) |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2026-06-04 |