| NPI | 1871889675 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A122737) | 
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA A122737) | 
| Enumeration Date | 2011-06-21 | 
| Last Update Date | 2025-10-01 |