| NPI | 1912929910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: OR MD21268) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD21268) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2024-01-16 |