| NPI | 1124328430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MA 259994) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 259994) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2024-08-27 |