| NPI | 1508253634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1024921) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: MA 1024921) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA A165043) | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2026-08-21 |