| NPI | 1245525765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35.124309) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.124309) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CT 055401) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 055401) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2018-03-17 |