| NPI | 1902822059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G069064) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA G069064) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA G069064) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: CA G069064) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CA G69064) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2019-08-10 |