| NPI | 1558882860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: VA 0102206429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS019982) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2021-11-02 |