| NPI | 1871932368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine (Licence: OR 209907) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 054588) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2022-07-04 |