| NPI | 1942592514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1026351) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CT 053445) |
| 207Q00000X Family Medicine (Licence: CT 53445) | |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2026-05-04 |