| NPI | 1821409731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OR MD177006) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK MD17706) |
| 207Q00000X Family Medicine (Licence: OR MD177006) | |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2023-03-22 |