| NPI | 1972630903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CO 38679) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 38679) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2011-02-04 |