| NPI | 1841844115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G60750) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: CA G60750) |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2021-11-09 |