| NPI | 1417901232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MI 4301034105) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 034105) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2025-08-06 |