| NPI | 1487147435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 55759) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP227) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2022-02-14 |