| NPI | 1952330771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME75719) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL XS3211810) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME75719) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2022-01-13 |