| NPI | 1790147130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 283855) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: MA 283855) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2021-12-16 |