| NPI | 1417917782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 022337) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: LA 022337) |
| 2083A0300X Preventive Medicine Addiction Medicine (Licence: LA 022337) | |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: LA 022337) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2022-01-21 |