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 |