| NPI | 1013103076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 86214) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP295) |
| Enumeration Date | 2007-09-23 |
| Last Update Date | 2023-12-12 |