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 |