| NPI | 1124516620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD223912) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OR MD223912) |
| 207R00000X Internal Medicine (Licence: SD 12780) | |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2026-08-13 |