NPI | 1962407692 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A 7439) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI DOS-924) |
207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A2439) | |
Enumeration Date | 2005-06-17 |
Last Update Date | 2015-11-04 |