| NPI | 1972619864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI RI6534) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: RI MD06534) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2018-03-23 |