| NPI | 1982689600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NC 26310) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 26310) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NC 26310) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2011-10-06 |