| NPI | 1699746446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA C41489) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA C41489) |
| 208D00000X General Practice (Licence: CA C41489) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2022-09-12 |