| NPI | 1194708396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 25653) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0058409) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2011-08-23 |