| NPI | 1588168850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: PR 21671) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21671) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2025-06-30 |