| NPI | 1558756262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 50369) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: CA 50369) |
| 208U00000X Clinical Pharmacology (Licence: CA 50369) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2015-03-30 |