| NPI | 1043323058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0101043050) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: VA 0101043050) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2022-01-05 |