| NPI | 1659394633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 92103) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A92103) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-02-03 |