| NPI | 1619967007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A88670) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A88670) |
| 207Q00000X Family Medicine (Licence: PA MD428878) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2024-08-12 |