| NPI | 1033590542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 51340) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP467) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2018-07-02 |