| NPI | 1811551468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101026531) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: MI 5101026531) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2024-01-16 |