| NPI | 1558328179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 29912) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WV 18116) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: WV 18116) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: WV 18116) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: WV 18116) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: KY 29912) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2023-08-01 |