| NPI | 1215399092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: TN 3763) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 3763) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN 101770796) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2025-08-27 |