| NPI | 1790980225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 239180) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-231739) |
| 207RA0401X Internal Medicine Addiction Medicine (Licence: MA 239180) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2022-08-22 |