| NPI | 1376802157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 04048) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R2868) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2020-01-16 |