| 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 |