| NPI | 1154563245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: PR 24194) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine (Licence: PR 24194) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: PR 24194) | |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2025-09-13 |