| NPI | 1972538106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA 181231) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301080382) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301080382) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NC 2021-01167) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NC 2021-01167) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2022-08-14 |