NPI | 1265926661 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022007809) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT216745) |
207Q00000X Family Medicine (Licence: PA MD475598) | |
207QA0401X Family Medicine, Addiction Medicine (Licence: MO 2022007809) | |
Enumeration Date | 2018-06-19 |
Last Update Date | 2022-07-27 |