| NPI | 1437100898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C55199) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA C55199) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2023-03-07 |