| NPI | 1285726505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: KY 14035) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: KY 14035) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-08 |