| NPI | 1033247630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: AZ 11336) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: AZ MD11336) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2012-02-17 |