| NPI | 1770651200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD173966) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301081783) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: OR MD173966) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2021-02-19 |