| NPI | 1801881016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: IN 02000860C) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: TX T1985) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: IN 02000860A) | |
| 207Q00000X Family Medicine (Licence: IN 02000860A) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: TX T1985) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2024-03-07 |