| NPI | 1629305479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A5348) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A5348) |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2024-06-17 |