| NPI | 1205325800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-00519) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: MA 286986) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2025-09-03 |