| NPI | 1043475361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 41302) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 41302) |
| 207P00000X Emergency Medicine (Licence: KY 41302) | |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2015-05-12 |