| NPI | 1306996079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY 48369) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: KY 48369) |
| 208600000X Surgery (Licence: NH 13748) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2019-07-09 |