| NPI | 1699188334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NC 2016-02067) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 201026) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: TN 72218) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: GA 92771) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2025-08-21 |