| NPI | 1407907603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: WV 31684) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 204928) |
| 207Q00000X Family Medicine (Licence: WV 31684) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2023-01-28 |