NPI | 1750465910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME72995) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME72995) |
Enumeration Date | 2006-10-24 |
Last Update Date | 2019-04-11 |