| NPI | 1205895943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 33614) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 33614) |
| 207Q00000X Family Medicine (Licence: KY 33614) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2025-07-15 |