| NPI | 1407895972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: KY 03784) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MS 15435) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-04-26 |