| NPI | 1275511404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1674) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 02693) |
| 207Q00000X Family Medicine (Licence: KY 02693) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2020-11-12 |