| NPI | 1164952941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A169931) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10929) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2025-09-11 |