| NPI | 1710542261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD61495762) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 56718) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2024-01-22 |