| NPI | 1508833989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 26020) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: KY 26020) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2020-12-17 |