| NPI | 1225324775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 207371) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY MD.207371) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2021-08-04 |