| NPI | 1871517912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NM MD2019-0018) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO CDRH.0054001) |
| 207Q00000X Family Medicine (Licence: NM MD2019-0018) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-12-12 |