| NPI | 1144458217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0073466) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MD d0073466) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2022-08-26 |