| NPI | 1215919451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 02320) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: KY 02320) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 02320) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: KY 02320) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: KY 02320) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2009-12-14 |