| NPI | 1619249034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA A133836) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A133836) |
| 207P00000X Emergency Medicine (Licence: OR MD180706) | |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2025-07-03 |