| NPI | 1790045102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD043670) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: DC MD043670) |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2020-04-06 |