Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | NJ |
NPI | 1619051711 |
---|---|
Provider Name | David Canavan |
First Address | Lawrenceville, NJ 08648-1565 |
Second Address | Princeton, NJ 08650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |