NPI | 1821178005 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA 0S006737L) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 0S006737L) |
Enumeration Date | 2006-10-16 |
Last Update Date | 2018-03-17 |