| NPI | 1629431796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D87025) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MD D0087025) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2026-01-30 |