| NPI | 1851313266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 02805) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: KY 02805) |
| 207P00000X Emergency Medicine (Licence: KY 02805) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2024-09-17 |