| NPI | 1114052677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: KY 16772) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: KY 16772) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2017-05-05 |