| NPI | 1346212545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: WI 39133) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: WI 39133) |
| 207R00000X Internal Medicine (Licence: WI 39133) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2012-10-20 |