| NPI | 1548309651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A6829) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 2oa6829) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: WA OP61153857) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2024-05-07 |