| NPI | 1821095787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 31351) |
| Additional Taxonomies | 163WI0500X Registered Nurse, Infusion Therapy (Licence: IA 31351) |
| 202C00000X Independent Medical Examiner (Licence: IA 31351) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: IA 31351) | |
| 261QU0200X Clinic/Center, Urgent Care (Licence: IA 31351) | |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2020-02-10 |