| NPI | 1194794701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L8295) |
| 207Q00000X Family Medicine (Licence: KY TP366) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2015-04-21 |