| NPI | 1215993993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MA 57365) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MA XS49444486) |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2026-05-28 |