| NPI | 1154514347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 41342) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101256554) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2019-11-07 |