| NPI | 1194799676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 14523/DEA#AT3037252) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY AT3037252) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2024-05-09 |