| NPI | 1174685721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 328058) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NM A-1656-12) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NM A-1656-12) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2024-04-30 |