| NPI | 1972506616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA 20A-8534) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AZ 005389) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: AZ 5389) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: AZ 5389) | |
| 207Q00000X Family Medicine (Licence: CA 20A8534) | |
| 207P00000X Emergency Medicine (Licence: CA 20A8534) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA 20A-8534) | |
| Enumeration Date | 2005-05-25 |
| Last Update Date | 2026-05-23 |