| NPI | 1275911562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A145584) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A145584) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA A145584) | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2025-02-07 |