| NPI | 1609224575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CO CDRH.0062970) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 12022) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2025-07-10 |