NPI | 1417916198 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CO 25292) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 25292) |
Enumeration Date | 2006-03-21 |
Last Update Date | 2018-11-15 |