| NPI | 1154396711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D0033407) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MD D0033407) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2026-07-30 |