| NPI | 1649701251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 190140) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 190140) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2025-12-10 |