| NPI | 1194913533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0010124635) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: VA 0101246355) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: VA 0010124635) | |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2020-08-13 |