| NPI | 1497800270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: TN 3693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 73404) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: OR DO180819) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: WA OP60800091) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2024-03-11 |