| NPI | 1720512692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 286904) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MA 286904) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2022-08-19 |