| NPI | 1568515419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 12515R) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: GA 84438) |
| 405300000X Prevention Professional (Licence: LA 12515R) | |
| 405300000X Prevention Professional (Licence: GA 84438) | |
| 207Q00000X Family Medicine (Licence: GA 84438) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: LA 12515R) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2020-05-12 |