| NPI | 1366437097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 31736) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 31736) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: KY 31736) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2024-05-07 |