| 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 |