| NPI | 1831144872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OR MD26161) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD26161) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OR MD26161) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2019-01-07 |