| NPI | 1316407034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: WA MD61190294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61190294) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2023-10-05 |