| NPI | 1588152367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME159301) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.246390) |
| 207RA0401X Internal Medicine Addiction Medicine (Licence: FL ME159301) | |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2024-07-05 |