| NPI | 1255310108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME102631) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD 039970 E) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2021-04-29 |