| NPI | 1477004372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 04671) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-3267) |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2020-02-19 |