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 |