NPI | 1477166536 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: LA 214564) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA 214564) |
Enumeration Date | 2020-08-28 |
Last Update Date | 2023-12-11 |