| NPI | 1629270962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 203557) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: LA MD.203557) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2021-09-28 |