| NPI | 1588984751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A132993) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD184793) |
| 207Q00000X Family Medicine (Licence: TX P2549) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA A132993) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: OR MD184793) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: TX P2549) | |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2021-12-10 |