| NPI | 1417397076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03709) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R3058) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2024-11-06 |