| NPI | 1811578461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 191827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 191827) |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2025-10-06 |