| NPI | 1538108758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL 10661) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO DO 110214) |
| 208000000X Pediatrics (Licence: NY 242970) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL 10661) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2024-05-09 |