| NPI | 1295900629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NC 2021-03413) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 51117) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MN 51117) | |
| Enumeration Date | 2008-04-27 |
| Last Update Date | 2023-01-07 |