| NPI | 1063432730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 02893) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 02893) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2021-04-26 |