| NPI | 1447209994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: VA 0101034409) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101034409) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NC 2022-01239) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2022-12-22 |