| NPI | 1891944708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: TN 45956) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 45956) |
| 207P00000X Emergency Medicine (Licence: TX N4707) | |
| 207Q00000X Family Medicine (Licence: TX N4707) | |
| 207Q00000X Family Medicine (Licence: TN 45956) | |
| 207Q00000X Family Medicine (Licence: KY 56738) | |
| 208D00000X General Practice (Licence: TN 45956) | |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2022-11-03 |