| NPI | 1114970753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 207790) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 207790) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2019-02-10 |