| NPI | 1053381863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 20744) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NC 20744) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2020-06-10 |