| NPI | 1679926059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 55768) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT210892) |
| 207P00000X Emergency Medicine (Licence: KY TP361) | |
| 207PT0002X Emergency Medicine, Medical Toxicology (Licence: KY 55768) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY 55768) | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2023-04-17 |