| NPI | 1174890792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: WI 67258-20) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35.122534) |
| 208M00000X Hospitalist (Licence: OH 35.122534) | |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2022-07-21 |