| NPI | 1184190712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: TN 29915) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TN 29915) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TN 29915) | |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2022-04-12 |