| NPI | 1043231038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C54436) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 20901) |
| 207Q00000X Family Medicine (Licence: KY 20901) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-01-07 |