| NPI | 1093815755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 23029) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 45792) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2023-08-01 |