| NPI | 1912526559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 73630) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: UT 13396312-1205) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2024-08-05 |