| NPI | 1639179807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME70790) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2021-03416) |
| 207RA0401X Internal Medicine Addiction Medicine (Licence: FL ME70790) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2022-12-13 |