| NPI | 1881186773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A24263) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.172794) |
| 207Q00000X Family Medicine (Licence: KS 05-50903) | |
| 207Q00000X Family Medicine (Licence: AZ 009149) | |
| 207Q00000X Family Medicine (Licence: IN 02008364A) | |
| 207Q00000X Family Medicine (Licence: UT 14215278-1234) | |
| 207Q00000X Family Medicine (Licence: WI 13089-321) | |
| 207Q00000X Family Medicine (Licence: PA OS024759) | |
| 207Q00000X Family Medicine (Licence: NC 01760) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: IL 336.128366) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: UT 12415278-8904) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MS 35040) | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2025-07-22 |