| NPI | 1568573152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 37264) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY 37264) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2026-07-06 |