| NPI | 1104110329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 1485) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: SC 1485) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2026-09-16 |