| NPI | 1174518708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NH 15037) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VT 042-0008688) |
| 207P00000X Emergency Medicine (Licence: MA 282042) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: NH 15037) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2024-06-04 |