| NPI | 1518958420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101238297) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: VA 0101238297) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2022-01-11 |