| NPI | 1427463454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY R3173) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 03979) |
| Enumeration Date | 2014-06-28 |
| Last Update Date | 2019-01-11 |