| NPI | 1982762761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA G36991) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA G36991) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2012-10-06 |