| NPI | 1104865674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 21485) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY 21485) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2015-09-18 |