| NPI | 1790984623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: IL 036160445) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 053061) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: WA IMLC.MD.61015852) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0101270615) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MD D0090402) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CO 53061) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2023-03-22 |