| NPI | 1811932700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 6169601-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 18111) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TN 5014) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY C0989) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2022-11-19 |