NPI | 1598757114 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: AZ 2226) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 2226) |
Enumeration Date | 2005-08-19 |
Last Update Date | 2020-03-06 |