| NPI | 1114241064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 64538) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 23994) |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2019-06-27 |