| NPI | 1205399730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MD d97715) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D97715) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2023-08-18 |