| NPI | 1063488831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 2021-00315) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2021-00315) |
| 207Q00000X Family Medicine (Licence: TN MD30708) | |
| 207Q00000X Family Medicine (Licence: TX T8718) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NC 2021-00315) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2022-11-08 |