| NPI | 1235577628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 48628) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R3057) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2016-04-11 |