| NPI | 1043396211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TX G8012) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 68012) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: TX G8012) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2023-02-21 |