| NPI | 1104372200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine (Licence: NM MD2022-1359) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2020-0468) |
| 207R00000X Internal Medicine (Licence: IL 125.067977) | |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2024-09-25 |