| NPI | 1477550960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD035627L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO Dr.0049839) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: CO DR.0049839) | |
| 251S00000X Community/Behavioral Health (Licence: CO AF6214960) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2023-02-10 |