| NPI | 1033118864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY KY32608) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 32608) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2021-01-06 |