| NPI | 1952511917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME110079) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2014013908) |
| 207R00000X Internal Medicine (Licence: KY 48651) | |
| 207R00000X Internal Medicine (Licence: NY 2552631) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY 48651) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2022-08-19 |