| NPI | 1134823032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 06166) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R6530) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2026-05-18 |