| NPI | 1093249864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 1211497) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA 61-25999) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2025-05-27 |