NPI | 1801881016 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: IN 02000860C) |
Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: TX T1985) |
261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
207LP2900X Anesthesiology Pain Medicine (Licence: IN 02000860A) | |
207Q00000X Family Medicine (Licence: IN 02000860A) | |
207QA0401X Family Medicine Addiction Medicine (Licence: TX T1985) | |
Enumeration Date | 2005-09-14 |
Last Update Date | 2024-03-07 |