| NPI | 1205048212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 43380) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 43380) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: KY 43380) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2018-12-10 |