| NPI | 1629573936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: GA 91068) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 91068) |
| 207Q00000X Family Medicine (Licence: WY 14722A) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: GA 91068) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: NJ 25MA11151100) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2024-07-08 |