| NPI | 1043645146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS13485) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: FL DOOS13485) |
| 207QA0401X Family Medicine Addiction Medicine (Licence: FL OS13485) | |
| 207Q00000X Family Medicine (Licence: FL UO3376) | |
| Enumeration Date | 2013-09-08 |
| Last Update Date | 2020-10-20 |