| NPI | 1417996331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2006-01743) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 41168) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-01-13 |