| NPI | 1588692503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 02979) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 02979) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2021-02-03 |