| NPI | 1003436296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WI 83825) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MN 69943) |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2024-08-27 |