| NPI | 1346519071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: AK 1526) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: AZ 33152) |
| Enumeration Date | 2011-12-27 |
| Last Update Date | 2011-12-27 |