| NPI | 1891085882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine (Licence: NM MD2014-0199) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2014-0199) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2024-06-06 |