| NPI | 1285214031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NY 330639) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 330639) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2025-08-19 |