| NPI | 1982764551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY 23326) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 23326) |
| 207Q00000X Family Medicine (Licence: KY KY23326) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2019-12-13 |