| NPI | 1427137256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NY 206098-1) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 2060981) |
| 208D00000X General Practice (Licence: NY 206098) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2020-03-19 |