| NPI | 1427430644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 04139) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 04139) |
| 207Q00000X Family Medicine (Licence: KY R3589) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2021-01-22 |