| NPI | 1487065694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 04113) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 04113) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2023-06-15 |