| NPI | 1184039240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 27985) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R3259) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2021-12-10 |