| NPI | 1467283051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 95031622) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95031622) |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2024-11-12 |