| NPI | 1366742629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A74169) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A74169) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2020-08-20 |