NPI | 1750581096 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: CA C50114) |
Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA C50114) |
207QA0505X Family Medicine, Adult Medicine (Licence: CA C50114) | |
207QS0010X Family Medicine, Sports Medicine (Licence: CA C50114) | |
Enumeration Date | 2007-07-24 |
Last Update Date | 2020-05-13 |