| NPI | 1154680668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A148861) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A148861) |
| 207Q00000X Family Medicine (Licence: KY 47916) | |
| 207Q00000X Family Medicine (Licence: FL ME 124874) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME124874) | |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2022-08-18 |