| NPI | 1730523069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine (Licence: NY 284531) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 284531) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2025-07-09 |