| NPI | 1104881101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME0072588) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 042.0014077) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2025-05-13 |