| NPI | 1437495421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 277455) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 277455) |
| 207QA0401X Family Medicine Addiction Medicine (Licence: NY 277455) | |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2020-12-01 |