| NPI | 1386870046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 45425) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 31727) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2019-08-27 |