| NPI | 1962416578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 6957) |
| Additional Taxonomies | 174400000X Specialist (Licence: NH 6957) |
| 207QA0401X Family Medicine Addiction Medicine (Licence: NH 6957) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2025-06-22 |