| NPI | 1750348421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: SC 85777) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD035160E) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: DE C1-0013325) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: NC 2022-00312) | |
| 207R00000X Internal Medicine (Licence: NC 2022-00312) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2022-00312) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2023-09-12 |