NPI | 1174599344 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 4301072802) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301072802) |
Enumeration Date | 2006-02-27 |
Last Update Date | 2023-07-11 |