| NPI | 1790745495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 200401292) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 200401292) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 61-2351) | |
| 207R00000X Internal Medicine (Licence: SC 27357) | |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2020-08-03 |