| NPI | 1548273055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine (Licence: AZ 21360) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 21360) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2023-07-18 |