| NPI | 1619967577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OR MD14502) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: HI MD-17867) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2021-04-14 |