| NPI | 1326033887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 36976) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01057382A) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2014-08-21 |