| NPI | 1568881977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A168924) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 30648) |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: CA A168924) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A168924) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA A168924) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A168924) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA A168924) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2023-01-23 |