| NPI | 1104854090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 33738) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 33738) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2015-05-05 |