| NPI | 1972742963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY 42910) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 42910) |
| Enumeration Date | 2009-02-13 |
| Last Update Date | 2023-11-08 |