| NPI | 1508253634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA A165043) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-RES-LIC-42280) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2024-03-20 |