| NPI | 1871144618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME165419) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL 165419) |
| 208D00000X General Practice (Licence: MO 2018035138) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN36680) | |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2024-11-13 |