| NPI | 1891371563 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A188787) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA A188787) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2026-09-04 |