| NPI | 1851873079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MO 2025040388) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: AL DO.2708) |
| 207Q00000X Family Medicine (Licence: AL DO.2708) | |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2026-06-09 |