| NPI | 1003011958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: GA GA 017901) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 017901) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: GA 017901) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2012-02-02 |