| NPI | 1245760495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019011044) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 12326A) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MO 2019011044) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2020-07-09 |