| NPI | 1619089943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G60275) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA G60275) |
| 207QA0401X Family Medicine Addiction Medicine (Licence: CA G60275) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2018-03-17 |