| NPI | 1952556094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: LA 024643) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MS 18116) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2021-07-08 |