| NPI | 1558332833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9500419) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 9500419) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 9500419) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2020-08-20 |