| NPI | 1902195571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 259191) |
| Additional Taxonomies | 2083A0300X Preventive Medicine Addiction Medicine (Licence: MA 259191) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2022-01-11 |