| NPI | 1215513155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 25897) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NV 25897) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-09-15 |