| NPI | 1972686707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CT 027646) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CT 027646) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2010-10-27 |