| NPI | 1992248355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: ID 0-1585) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: AL DO.2039) |
| 207QA0401X Family Medicine Addiction Medicine (Licence: FL OS17721) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2022-04-01 |