| NPI | 1366449159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 25490) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: KY 25490) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-09-30 |