| NPI | 1891960431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 51852) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207QA0505X Family Medicine, Adult Medicine (Licence: AR E-7091) | |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2018-09-24 |