| NPI | 1497769764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 187489) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 187489) |
| 207Q00000X Family Medicine (Licence: NY 187489) | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2021-04-28 |