| NPI | 1326131715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NY 119746-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 119746) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 1197461) | |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2013-07-19 |