| NPI | 1508882010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 43994-A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY 43994) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 43994) | |
| 207P00000X Emergency Medicine (Licence: KY 43994) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2025-12-15 |