| NPI | 1376708438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 44455) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL 30782) |
| 207Q00000X Family Medicine (Licence: SC 30782) | |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2022-09-26 |