| NPI | 1801241104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NC 2017-02380) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 217975) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NC 2017-02380) | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2025-06-16 |