| NPI | 1700467537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14224208-1204) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: UT 14224208-1204) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2025-08-27 |