| NPI | 1093896870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 183666) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NY 183666) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2024-04-30 |