| NPI | 1639432537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A-20105) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A-20105) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A-20105) | |
| Enumeration Date | 2012-06-17 |
| Last Update Date | 2026-04-21 |