| NPI | 1649808171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine (Licence: WA OP61569545) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: OR DO214799) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2024-08-07 |