| NPI | 1710088877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 31140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 31140) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2021-04-19 |