NPI | 1407883820 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: LA 016313) |
Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: LA 016313) |
Enumeration Date | 2006-06-28 |
Last Update Date | 2021-10-14 |