| NPI | 1073545232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101035687) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: VA 0101035687) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-12-20 |