| NPI | 1376808493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0102207857) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 34.015624) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: PA OS021113) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MN 72166) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CT 68601) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: DC DO034631) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: VA 0102207857) | |
| 208D00000X General Practice (Licence: MI 5101020806) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2025-01-10 |