| NPI | 1013054626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: KY 41461) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 41461) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2022-02-25 |