| NPI | 1366887846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA os018660) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA os018660) |
| 207Q00000X Family Medicine (Licence: NY 287966) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2020-11-11 |