NPI | 1740635523 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 65998) |
Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MN 65998) |
Enumeration Date | 2016-04-28 |
Last Update Date | 2021-06-16 |