| NPI | 1881675999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine (Licence: FL ME0069749) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0069749) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2019-05-28 |