| NPI | 1619932084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY 36961) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 36961) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: IN 01061356A) | |
| 207R00000X Internal Medicine (Licence: KY 36961) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2021-04-15 |