| NPI | 1376677757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 154361) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NY 154361) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2024-12-02 |