| NPI | 1689683658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 36694) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 36694) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2019-12-05 |