| NPI | 1922531524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine (Licence: CA A181897) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101268845) |
| 207QA0401X Family Medicine Addiction Medicine (Licence: VA 0101268845) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2024-01-20 |