| NPI | 1528090040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 160892) |
| Additional Taxonomies | 2083A0300X Preventive Medicine Addiction Medicine (Licence: CA C168953) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-02-02 |