NPI | 1427034529 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME139673) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 14752) |
207QA0401X Family Medicine, Addiction Medicine (Licence: WV 14752) | |
Enumeration Date | 2005-12-20 |
Last Update Date | 2025-08-18 |