| NPI | 1326048976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: WI 37915) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 37915) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2022-07-21 |