| NPI | 1265422695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA G40600) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA G40600) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA G40600) | |
| 101YM0800X Counselor, Mental Health (Licence: CA G40600) | |
| 174400000X Specialist (Licence: CA G40600) | |
| 1744R1102X Specialist, Research Study (Licence: CA G40600) | |
| 1744R1103X Specialist, Research Data Abstracter/Coder (Licence: CA G40600) | |
| 207Q00000X Family Medicine (Licence: CA G40600) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CA G40600) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA G40600) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2024-10-22 |