| NPI | 1366187700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: VA 0101285872) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD486411) |
| Enumeration Date | 2022-04-30 |
| Last Update Date | 2025-07-07 |