| NPI | 1982109740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: NY 312837) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 312837) |
| 207QA0401X Family Medicine Addiction Medicine (Licence: CA A163513) | |
| 207Q00000X Family Medicine (Licence: CA A163513) | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2023-03-08 |