| NPI | 1003834540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 18412) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY 18412) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2015-06-08 |