| NPI | 1962409292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MI 4301041195) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301041195) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2010-01-12 |