| NPI | 1639182660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NH 10884) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: VT 0320000522) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-04-20 |