| NPI | 1114254000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA G70964) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G070964) |
| Enumeration Date | 2009-11-12 |
| Last Update Date | 2025-03-24 |