| NPI | 1093027013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 5101021701) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021701) |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2019-07-05 |