| NPI | 1679653976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A5572) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A5572) |
| 207Q00000X Family Medicine (Licence: CA 20A5572) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2024-01-15 |