| NPI | 1538225776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: TX K4632) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NV 10620) |
| 207Q00000X Family Medicine (Licence: NV 10620) | |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2024-01-09 |