| NPI | 1164785457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 48684) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 48684) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2016-05-06 |