| NPI | 1083047260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: CA 17366) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 17366) |
| 207R00000X Internal Medicine (Licence: FL 19123) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL 19123) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL 19123) | |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2024-06-14 |