| NPI | 1669506861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 25939) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 25939) |
| 208600000X Surgery (Licence: NC 25939) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-04-04 |