| NPI | 1952363707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MA 45369) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 45369) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2018-09-22 |