| NPI | 1366887846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: TX V0450) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: TX V0450) |
| 207Q00000X Family Medicine (Licence: NY 287966) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: PA os018660) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207P00000X Emergency Medicine (Licence: PA os018660) | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2026-03-31 |