| NPI | 1437105665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 201200924) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35040837F) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2026-01-16 |