| NPI | 1720017056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CT 018720) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CT 01870) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2020-09-04 |