| NPI | 1629484811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA A148450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A148450) |
| 207R00000X Internal Medicine (Licence: IL 125.065956) | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2024-04-29 |