| NPI | 1649701251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: CA 190140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 57423) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2024-09-19 |