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 |