| NPI | 1609869833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME122201) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME122201) |
| 207R00000X Internal Medicine (Licence: FL ME122201) | |
| 207R00000X Internal Medicine (Licence: NY 210461) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2024-03-21 |