| NPI | 1063651974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: KY 43203) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY 43203) |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2019-12-03 |