| NPI | 1972130664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA A182177) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 6333) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-07-03 |