| NPI | 1891720587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 22708) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: KY 22708) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2015-06-13 |