| NPI | 1508819269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME127760) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME127760) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: GA 034584) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2018-08-08 |