| NPI | 1184061376 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2024-0458) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A132679) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: NM MD2024-0458) | |
| 207R00000X Internal Medicine (Licence: CA A132679) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2024-06-06 |