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 |