| NPI | 1063779163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A138224) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A138224) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A138224) | |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2021-01-07 |