| NPI | 1407346927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CO DR0071855) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10063987) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: TX S3041) | |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2024-09-17 |