| NPI | 1083979066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 65003) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 290843) |
| 207R00000X Internal Medicine (Licence: NJ 25MA10257400) | |
| 207RA0401X Internal Medicine Addiction Medicine (Licence: FL ME133449) | |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2020-03-23 |