| NPI | 1194708776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 26429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 26429) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2023-12-01 |