| NPI | 1962509521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME34296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 0034296F) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2018-03-17 |