| NPI | 1306294764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MA 283531) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 62519) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: CT 62519) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2020-06-25 |