| NPI | 1710964226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: AR E-11924) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L3053) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2023-03-07 |