| NPI | 1235132333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 37369) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: KY 37369) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2010-01-12 |