| NPI | 1275602070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 02799) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: KY 02799) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2017-07-14 |