| NPI | 1689369332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A25204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV DO3967) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2026-07-02 |