| NPI | 1568615847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 31272) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY 31272) |
| 208000000X Pediatrics (Licence: KY 31272) | |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2022-04-06 |