| NPI | 1821385592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301510341) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL TPME6158) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 4301510341) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ 273694) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: AZ THMD00139) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 273694) | |
| 207Q00000X Family Medicine (Licence: AZ THMD00139) | |
| 207Q00000X Family Medicine (Licence: FL TPME6158) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2024-01-28 |