| NPI | 1457604944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C0004855) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MD C0004855) |
| Enumeration Date | 2012-10-21 |
| Last Update Date | 2023-11-28 |