| NPI | 1801576376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0024187594) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0024187594) |
| Enumeration Date | 2023-07-20 |
| Last Update Date | 2023-07-20 |