| NPI | 1609859297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: AZ 65316) |
| Additional Taxonomies | 174400000X Specialist (Licence: UT 181682-1205) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: UT 1816821205) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2022-09-13 |