| NPI | 1578055984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MN 72173) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: IL 036157315) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2023-07-24 |