| NPI | 1316135833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: KY 45969) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 45969) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: KY 45969) | |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2015-11-30 |