| NPI | 1548671688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q6462) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: TX Q6462) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2021-08-16 |