| NPI | 1831757350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: LA 342972) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: PR 22074) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2025-01-28 |