| NPI | 1336793264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MI 5601009538) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5601009538) |
| 363A00000X Physician Assistant (Licence: MI 5601009538) | |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2024-02-24 |