| NPI | 1366972135 |
|---|---|
| Former Name | MEGAN ROSE WEINAND |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 59481) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NM MD2019-0662) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2023-05-21 |