| NPI | 1083633580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MA 52862) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MA 52862) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2012-05-31 |