| NPI | 1144882879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MA 291350) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MDRE.ML.60958797) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2022-11-23 |