| NPI | 1639100712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: AL MD.41888) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 48872) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2023-12-06 |