| NPI | 1184111700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD474676) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: PA MT216477) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2025-04-16 |