| NPI | 1396832978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NY 195447) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 195447) |
| 208D00000X General Practice (Licence: NY 195447) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2022-02-15 |