| NPI | 1023056959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 32932) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 32932) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2021-06-04 |