| NPI | 1912290859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD484549) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD0000051650) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 00202) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2024-06-17 |