| NPI | 1043506413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CO 52335) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P4832) |
| 207Q00000X Family Medicine (Licence: CO 52335) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2024-06-21 |