| NPI | 1043453749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 45462) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY FT436) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2018-03-21 |