| NPI | 1154420024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA A89818) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: CA A89818) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA A89818) | |
| 174400000X Specialist (Licence: CA A89818) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2019-08-08 |