| NPI | 1770649816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: CA 00G451440) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: CA G45144) |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2021-08-23 |