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 |