| NPI | 1447246186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 19912) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 19912) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: KY 19912) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2022-05-04 |