| NPI | 1487760419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 33507) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2017-00892) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2024-03-06 |