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 | 2023-08-16 |