| NPI | 1265666218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY 48494) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY 48494) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: KY 48494) | |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2021-01-26 |