| NPI | 1003194309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA C180637) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MA 287401) |
| 208D00000X General Practice (Licence: MI 4301501025) | |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2023-01-19 |