| NPI | 1801043799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A24305) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: CA A24305) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A24305) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA A24305) | |
| 208D00000X General Practice (Licence: CA A24305) | |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2016-08-18 |