| NPI | 1194125500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NY 171859) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 171859) |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2025-11-10 |