| NPI | 1619534575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0071075) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID O-1697) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: ID O-1697) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CO DR.0071075) | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2023-09-29 |