| NPI | 1952842932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15555) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL OS15555) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO T981356585) | |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2026-04-06 |