| NPI | 1902816549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: KY 34226) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: KY 34226) |
| 207Q00000X Family Medicine (Licence: KY 34226) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 34226) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: KY 34226) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2021-08-31 |