| NPI | 1073512984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-01798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY KY31452) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2020-11-17 |