| NPI | 1154479525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A4078) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA a4078) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA a4078) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2018-10-16 |