| NPI | 1801035886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A11246) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A11246) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A11246) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA A11246) | |
| Enumeration Date | 2009-02-13 |
| Last Update Date | 2017-03-30 |