| NPI | 1033596143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A167956) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0086197) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2021-03-03 |