| NPI | 1265534127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2025-00960) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NC 2025-00960) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2025-07-25 |