NPI | 1730176900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WV 17401) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 17401) |
Enumeration Date | 2005-10-04 |
Last Update Date | 2024-10-17 |