| NPI | 1124476270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A16567) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A16567) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA 20A16567) | |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2025-03-27 |