| NPI | 1093707564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine (Licence: KY 21427) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 21427) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2014-04-11 |