| NPI | 1518063585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01036153) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 23424) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 23424) | |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: KY 23424) | |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: IN 01036153A) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2016-03-04 |