| NPI | 1285921932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY KY03698) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 03698) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2021-02-24 |