| NPI | 1558809475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: AR PA-720) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AR PT2017-010) |
| Enumeration Date | 2017-02-11 |
| Last Update Date | 2023-03-21 |