| NPI | 1942522388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: OR MD18862) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD18862) |
| Enumeration Date | 2010-02-26 |
| Last Update Date | 2022-07-21 |