| NPI | 1053385872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME107351) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME107351) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: PA MD421569) | |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: FL ME107351) | |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2021-04-21 |