| NPI | 1548313950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0038971) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: FL ME38971) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2020-05-27 |