| NPI | 1578533766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: KY 35957) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 35957) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY 35957) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2025-08-06 |