NPI | 1861945487 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61363536) |
Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: OR MD188385) |
Enumeration Date | 2016-07-31 |
Last Update Date | 2024-04-01 |