| NPI | 1144228917 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI CP052322)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301052322)  | 
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: MI 4301052322)  | |
| Enumeration Date | 2005-07-14 | 
| Last Update Date | 2023-12-16 |