| NPI | 1013656883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A21624) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A21624) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2025-07-30 |