| NPI | 1205324852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A165183) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A165183) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2026-04-03 |