| NPI | 1740685387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A13506) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A13506) |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2024-06-26 |