| NPI | 1013399195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A14895) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A14895) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA 20A14895) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2022-05-02 |