| NPI | 1205217924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 311740) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT016780) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2021-09-01 |