| NPI | 1568484780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NY 145320) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 145320) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2020-06-05 |