| NPI | 1598260663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD212118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA MCS006438A) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: OR MD212118) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: OR MD212118) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2022-08-22 |