| NPI | 1740802313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U3200) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: TX U3200) |
| Enumeration Date | 2020-05-17 |
| Last Update Date | 2025-03-01 |